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Gao X, Yan Y, Xiang S, Zeng G, Liu S, Sha T, He Q, Li H, Tan S, Chen C, Li L, Yan Q. The mutual effect of pre-pregnancy body mass index, waist circumference and gestational weight gain on obesity-related adverse pregnancy outcomes: A birth cohort study. PLoS One 2017; 12:e0177418. [PMID: 28575041 PMCID: PMC5456032 DOI: 10.1371/journal.pone.0177418] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/26/2017] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the mutual effect of pre-pregnancy body mass index (BMI), waist circumference (WC) and gestational weight gain (GWG) on obesity-related adverse pregnancy outcomes. METHODS This birth cohort study was conducted in three Streets in Changsha, China, including a total of 976 mother-child pairs. All data was collected within 15 days after deliveries from a self-administered questionnaire, maternal health manual and perinatal health care information system. Multivariate logistic regression models were conducted to estimate the effects of maternal pre-pregnancy BMI, WC and GWG on obesity-related adverse pregnancy outcomes including gestational diabetes mellitus (GDM), primary cesarean section (P-CS), large for gestational age (LGA) and composite outcome (one or more adverse pregnancy outcomes). RESULTS After controlling for all confounders, both maternal pre-pregnancy overweight/obesity and central adiposity contributed to increased risks of GDM [ORs 95% CIs = 2.19 (1.02-4.76) and 2.26 (1.11-4.60), respectively], P-CS [ORs 95% CIs = 1.66 (1.05-2.65) and 1.71 (1.11-2.63), respectively], LGA [ORs 95% CIs = 1.93 (1.07-3.50) and 2.14 (1.21-3.75), respectively] and composite outcome [ORs 95% CIs = 1.82 (1.15-2.87) and 1.98 (1.30-3.01), respectively] compared with mothers with normal pre-pregnancy weight and normal WC. Excessive GWG was found to be associated with an increased risk of LGA [OR 95% CI = 1.74 (1.05-2.89)], but was not significantly related to higher risks of GDM, P-CS and composite outcome [ORs 95% CIs = 0.90 (0.47-1.72), 1.08 (0.77-1.52), and 1.30 (0.94-1.79), respectively]. In terms of the joint effect of maternal pregestational BMI and WC on obesity-related composite outcome, mothers with both pre-pregnancy overweight and central adiposity had the highest risk of composite outcome [OR 95% CI = 3.96 (2.40-6.54)], compared with mothers without pre-pregnancy overweight or central adiposity. CONCLUSIONS The results of this study suggest that maternal pre-pregnancy overweight/obesity and central adiposity may contribute to multiple obesity-related adverse pregnancy outcomes, excessive weight gain during pregnancy is associated with an increased risk of LGA. Healthcare providers should carry out health education, and guide women to keep an ideal BMI and WC prior to pregnancy and help them gain optimal weight during pregnancy based on their pre-pregnancy BMI and WC.
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Affiliation(s)
- Xiao Gao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Yan Yan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
- * E-mail:
| | - Shiting Xiang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Guangyu Zeng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Shiping Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Tingting Sha
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Qiong He
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Hongyan Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Shan Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Cheng Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Ling Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Qiang Yan
- Department of Maternal and Child Health, Kaifu District Health Bureau, Changsha, China
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Liu YQ, Liu Y, Hua Y, Chen XL. Effect of diet and exercise intervention in Chinese pregnant women on gestational weight gain and perinatal outcomes: A quasi-experimental study. Appl Nurs Res 2017; 36:50-56. [PMID: 28720239 DOI: 10.1016/j.apnr.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 03/21/2017] [Accepted: 05/20/2017] [Indexed: 01/23/2023]
Abstract
Aim To determine the effect of a diet and exercise intervention in pregnant women on total gestational weight gain, weekly weight gain, 42-days postpartum weight retention, mode of delivery, and infant birth weight. METHODS One hundred and one eligible Chinese pregnant women whose pre-pregnancy body mass index ranged from 18.5 to 24.9 were recruited between June 2013 and June 2014 from a tertiary hospital. Ninety participants, 45 in each group, completed the study. Intervention women received three face-to-face interventions and three follow-up phone calls which were developed based on the Transtheoretical Model. Gestational weight was measured at each prenatal check. Mode of delivery and infant birth weight were collected from the medical record. The 42-days postpartum weight was measured during the postpartum visits. RESULTS (1) The total gestational weight gain and mean weight gain per week in the intervention group were significantly less than the control group (P=0.045 and P=0.008 respectively). (2) Infant birth weight was significantly lower in the intervention group (P=0.012). (3) Postpartum weight retention was significantly less in the intervention group (P=0.001). 4) There were not significant differences in mode of delivery. 5) Infant birth weight was significantly less than the control group (P=0.012). CONCLUSIONS The lifestyle intervention significantly reduced gestational weight gain, optimized infant weight and lowered postpartum weight retention. Promotion of gestational weight management is needed and cultural health beliefs about pregnancy and postpartum practices should be considered when developing the intervention plan.
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Affiliation(s)
- Yan Qun Liu
- Wuhan University School of Health Sciences, Wuhan University HOPE School of Nursing, 115 Donghu Road, Wuchang, Wuhan, Hubei Province, China.
| | - Yun Liu
- Wuhan University School of Health Sciences, Wuhan University HOPE School of Nursing, 115 Donghu Road, Wuchang, Wuhan, Hubei Province, China.
| | - Yun Hua
- Wuhan Women and Children Medical Care Center, 100 Xianggang Road, Hankou, Wuhan, Hubei Province, China.
| | - Xiao Li Chen
- Wuhan University School of Health Sciences, Wuhan University HOPE School of Nursing, 115 Donghu Road, Wuchang, Wuhan, Hubei Province, China.
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103
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Mokuolu OA, Akindele RN, Audu LI. Macrosomic births in abuja: A case–control study of predisposing factors and early neonatal outcome. Niger J Clin Pract 2017; 20:320-327. [PMID: 28256487 DOI: 10.4103/1119-3077.196060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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104
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Effect of maternal body mass index and weight gain in women with gestational diabetes on the incidence of large-for-gestational-age infants. DIABETES & METABOLISM 2016; 42:471-474. [DOI: 10.1016/j.diabet.2016.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 06/22/2016] [Accepted: 06/26/2016] [Indexed: 11/20/2022]
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105
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Yarrington CD, Cantonwine DE, Seely EW, Mcelrath TF, Zera CA. The association of early unexplained elevated alanine aminotransferase with large-for-gestational-age birthweight. Am J Obstet Gynecol 2016; 215:474.e1-5. [PMID: 27173083 DOI: 10.1016/j.ajog.2016.04.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/22/2016] [Accepted: 04/29/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nonalcoholic fatty liver disease causes hepatic insulin resistance and is associated with metabolic syndrome. Elevated levels of alanine aminotransferase are associated with nonalcoholic fatty liver disease. The effect of hepatic insulin resistance is not only increased glycogen breakdown but also liberation of free fatty acids due to increased lipolysis. Both of these fuel sources are associated with macrosomia. There is little known about the impact of maternal nonalcoholic fatty liver disease on excessive fetal growth. OBJECTIVE The purpose of this study was to investigate the association of early elevated alanine aminotransferase with large-for-gestational-age birthweight. STUDY DESIGN This is a secondary analysis from a nested case-control study of maternal alanine aminotransferase values measured between 8-18 weeks and subsequent gestational diabetes. We included women with singleton gestations with complete delivery information and without known diabetes, liver disease, or moderate self-reported alcohol use during pregnancy. We used inverse probability weighting to standardize the population and minimize selection bias. We calculated population-based birthweight z scores and defined large for gestational age as ≥90th percentile for gestational age. We compared maternal baseline characteristics with analysis of variance, Fisher exact test, or Wilcoxon rank sum. We then performed conditional logistic regression to evaluate the relationship between alanine aminotransferase and large for gestational age adjusting for maternal age, body mass index, parity, gestational diabetes, smoking, and maternal weight gain. RESULTS We identified 26 cases of large for gestational age out of 323 mother-infant dyads. The mean maternal body mass index was higher in the large-for-gestational-age group compared to controls (33.7 [SD 4.3] vs 28.9 [SD 6.5], P = .002). Large-for-gestational-age babies were less likely to be male (8 [31%] vs 172 [58%], P = .01) and had a higher mean gestational age (39.5 [SD 0.9] vs 38.4 [SD 2.3] weeks, P = .01). Maternal and infant characteristics were otherwise similar. The mean alanine aminotransferase among the large-for-gestational-age cases was 28 (SD 37) U/L compared to 16 (SD 8) U/L for controls. Each unit increase in log-transformed alanine aminotransferase was associated with a 3-fold odds of large for gestational age (adjusted odds ratio, 3.05; 95% confidence interval, 2.27-4.10; P < .0001), and alanine aminotransferase ≥90th percentile (26 U/L) was associated with a 4-fold increased odds of large for gestational age (adjusted odds ratio, 4.03; 95% confidence interval, 2.84-5.70; P < .0001). This association was unchanged when analysis was restricted only to women without gestational diabetes with a glucose loading test <120 mg/dL (log-transformed alanine aminotransferase: adjusted odds ratio, 3.05; 95% confidence interval, 1.04-8.96; P = .04, and alanine aminotransferase ≥90th percentile: adjusted odds ratio, 4.21; 95% confidence interval, 1.20-14.82; P = .03). CONCLUSION Unexplained elevated alanine aminotransferase in the first trimester was associated with a 4-fold increase in the odds of large-for-gestational-age birthweight even in the absence of clinical glucose intolerance. This may represent the impact of maternal nonalcoholic fatty liver on the fetal developmental milieu.
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Affiliation(s)
| | - David E Cantonwine
- Department of Maternal and Fetal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ellen W Seely
- Department of Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA
| | - Thomas F Mcelrath
- Department of Maternal and Fetal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Chloe A Zera
- Department of Maternal and Fetal Medicine, Brigham and Women's Hospital, Boston, MA
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106
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Xie YJ, Peng R, Han L, Zhou X, Xiong Z, Zhang Y, Li J, Yao R, Li T, Zhao Y. Associations of neonatal high birth weight with maternal pre-pregnancy body mass index and gestational weight gain: a case-control study in women from Chongqing, China. BMJ Open 2016; 6:e010935. [PMID: 27531723 PMCID: PMC5013473 DOI: 10.1136/bmjopen-2015-010935] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To examine the associations of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with neonatal high birth weight (HBW) in a sample of Chinese women living in southwest China. METHODS A hospital-based case-control study was conducted in Chongqing, China. A total of 221 mothers who delivered HBW babies (>4.0 kg) were recruited as cases and 221 age-matched (2-year interval) mothers with normal birth weight babies (2.5-4.0 kg) were identified as controls. ORs were estimated using conditional logistic regression analysis. For the analysis, pre-pregnancy BMI was categorised as underweight/normal weight/overweight and obesity and GWG was categorised as inadequate/appropriate/excessive. RESULTS Among the cases, mean pre-pregnancy BMI was 21.8±2.8 kg/m(2), mean GWG was 19.7±5.1 kg and mean neonatal birth weight was 4.2±0.2 kg. In the controls, the corresponding values were 21.1±3.1 kg/m(2), 16.4±5.0 kg and 3.3±0.4 kg, respectively. More cases than controls gained excessive weight during pregnancy (80.1% vs 48.4%, p<0.001). No significant association was found between pre-pregnancy BMI and HBW babies (OR=1.04, 95% CI 0.97 to 1.11; p>0.05). GWG was positively related to HBW after adjustment for gravidity, gestational age, newborns' gender and family income (OR=1.18, 95% CI 1.12 to 1.25; p<0.001). The adjusted OR of delivering HBW babies was 5.39 (95% CI 2.94 to 9.89; p<0.001) for excessive GWG versus appropriate GWG. This OR was strengthened among pre-pregnancy normal weight women (OR=10.27, 95% CI 3.20 to 32.95; p<0.001). CONCLUSIONS Overall, the findings suggest a significantly positive association between GWG and HBW. However, pre-pregnancy BMI shows no independent relationship with HBW.
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Affiliation(s)
- Yao Jie Xie
- College of Public Health and Management, Chongqing Medical University, Chongqing, China
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Rong Peng
- College of Public Health and Management, Chongqing Medical University, Chongqing, China
- Affiliated Hospital of Chengdu University, Chengdu, China
| | - Lingli Han
- College of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xiaoli Zhou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengai Xiong
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuan Zhang
- Chongqing Maternal and Child Health Care Hospital, Chongqing, China
| | - Junnan Li
- The First Affiliated Hospital of the Third Military Medical University, Chongqing, China
| | - Ruoxue Yao
- Department of Nutritional Sciences, University of Cincinnati, Cincinnati, USA
| | - Tingyu Li
- Children's Nutrition Research Centre, Key Laboratory of Developmental Diseases in Childhood of Education Ministry, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yong Zhao
- College of Public Health and Management, Chongqing Medical University, Chongqing, China
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107
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Strøm-Roum EM, Tanbo TG, Eskild A. The associations of maternal body mass index with birthweight and placental weight. Does maternal diabetes matter? A population study of 106 191 pregnancies. Acta Obstet Gynecol Scand 2016; 95:1162-70. [PMID: 27454190 DOI: 10.1111/aogs.12947] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/30/2016] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The aim of this study was to study whether the associations of maternal body mass index with offspring birthweight and placental weight differ by maternal diabetes status. MATERIAL AND METHODS We performed a population study of 106 191 singleton pregnancies by using data from the years 2009-2012 in the Medical Birth Registry of Norway. We estimated changes in birthweight and in placental weight (in grams) by maternal body mass index by linear regression analysis. RESULTS In pregnancies of women without diabetes, birthweight increased by 14.7 g (95% confidence interval 14.1-15.2) per unit increase in maternal body mass index, and the increase in placental weight was 4.2 g (95% confidence interval 4.0-4.4). In pregnancies of women with gestational diabetes, the corresponding figures were 11.8 g (95% confidence interval 8.3-15.4) and 2.9 g (95% confidence interval 1.7-4.0). In pregnancies of women with type 1 diabetes we found no significant changes in birthweight or in placental weight by maternal body mass index. Overall, mean birthweight was 513.9 g (95% confidence interval 475.6-552.1) higher in pregnancies involving type 1 diabetes than in pregnancies of women without diabetes. Mean placental weight was 102.1 g (95% confidence interval 89.3-114.9) higher. Also, in pregnancies of women with gestational diabetes, both birthweight and placental weight were higher than in women without diabetes (168.2 g and 46.5 g, respectively). Adjustments were made for maternal body mass index and gestational age at birth. CONCLUSIONS Birthweight and placental weight increased with increasing maternal body mass index in pregnancies of women without diabetes and in pregnancies of women with gestational diabetes, but not in pregnancies of women with type 1 diabetes. Independent of body mass index, mean birthweight and mean placental weight were highest in pregnancies of women with type 1 diabetes.
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Affiliation(s)
- Ellen M Strøm-Roum
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Tom G Tanbo
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Gynecology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Anne Eskild
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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108
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The Effects of Prepregnancy Body Mass Index and Gestational Weight Gain on Fetal Macrosomia Among American Indian/Alaska Native Women. Matern Child Health J 2016; 19:2480-91. [PMID: 26122253 DOI: 10.1007/s10995-015-1769-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The American Indian/Alaska Native (AI/AN) population is a high-risk group across many health indicators, including fetal macrosomia. We aimed to investigate the effects of prepregnancy body mass index (BMI) and gestational weight gain (GWG) on macrosomia and explore possible racial and geographical variations among AI/AN women. METHODS This retrospective cohort study was conducted from the Pregnancy Risk Assessment Monitoring System in eight states (2004-2011) among live, singleton, term births to AI/AN women 20 years or older. Prevalence of macrosomia (birth weight ≥ 4000 g) by select characteristics were estimated; differences were assessed with Chi-squares. Multivariable logistic regression was conducted to calculate adjusted odds ratios (aOR) for effects on macrosomia of BMI and GWG (enumerating the pounds women deviated from the Institute of Medicine guidelines for GWG) controlling for other factors in the total sample and stratified by race and state of residence. RESULTS The prevalence of macrosomia was 14 %, ranging from 8 to 21 % (Utah-Alaska). Among AI/AN women, 30 % were obese prepregnancy and 50 % had excess GWG. Significant independent effects were found for macrosomia of prepregnancy overweight (aOR 1.27; 95 % Confidence Interval 1.01-1.59), obesity (aOR 1.63; 1.29-2.07), and excess GWG (aOR 1.16; 1.13-1.20 per five pounds gained beyond appropriate). Adjusted estimates varied between race and state. CONCLUSIONS Prepregnancy BMI and GWG are independent factors for macrosomia among AI/AN women. Future research should prioritize development, testing, and implementation of weight management programs, which account for variations among AI/AN women, both before and during pregnancy for BMI regulation and GWG control.
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109
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Mourtakos SP, Tambalis KD, Panagiotakos DB, Antonogeorgos G, Alexi CD, Georgoulis M, Saade G, Sidossis LS. Association between gestational weight gain and risk of obesity in preadolescence: a longitudinal study (1997-2007) of 5125 children in Greece. J Hum Nutr Diet 2016; 30:51-58. [PMID: 27412890 DOI: 10.1111/jhn.12398] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The present study aimed to investigate the association between gestational weight gain (GWG) and birth weight, as well as the body mass index (BMI) status, of children at the ages of 2 and 8 years. METHODS Population-based data were obtained from a database of all 7-9-year-old Greek children who attended primary school during 1997-2007. The study sample consisted of 5125 children matched with their mothers, randomly selected according to region and place of residence, and equally distributed (approximately 500 per year) throughout the study period (1997-2007). A standardised questionnaire was applied; telephone interviews were carried out to collect maternal age, BMI status at the beginning and the end of pregnancy and GWG, birth weight of offspring and BMI status at the ages of 2 and 8 years, as well as several other pregnancy characteristics (e.g. pregnancy duration, gestational medical problems, maternal smoking and alcohol consumption habits, and lactation of offspring after pregnancy). RESULTS Gestational weight gain was positively associated with the weight status of offspring at all three life stages studied: newborn (birth weight), infant (BMI) and child (BMI) [b = 0.008 (0.001), b = 0.053 (0.009) and b = 0.034 (0.007), respectively, all P < 0.001], after adjusting for maternal age at pregnancy (significant inverse predictor only at age 2 years). The same applied to excessive GWG, as defined by the Institute of Medicine guidelines. CONCLUSIONS Excessive GWG was associated with a higher risk of greater infant size at birth and a higher BMI status at the ages of 2 and 8 years. Healthcare providers should encourage women to limit their GWG to the range indicated by the current guidelines.
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Affiliation(s)
- S P Mourtakos
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - K D Tambalis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.,Department of Physical Education and Sport Science, University of Athens, Athens, Greece
| | - D B Panagiotakos
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - G Antonogeorgos
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - C D Alexi
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - M Georgoulis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - G Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - L S Sidossis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.,Department of Internal Medicine, Sealy Center on Aging, Institute for Translational Sciences and Shriners Hospital for Children, University of Texas Medical Branch at Galveston, Galveston, TX, USA
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110
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Luhete PK, Mukuku O, Kiopin PM, Tambwe AM, Kayamba PKM. [Fetal macrosomia in Lubumbashi: risk factors and maternal and perinatal prognosis]. Pan Afr Med J 2016; 23:166. [PMID: 27303582 PMCID: PMC4894667 DOI: 10.11604/pamj.2016.23.166.7362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 02/02/2016] [Indexed: 02/05/2023] Open
Abstract
Introduction La macrosomie fœtale est habituellement définie par un poids de naissance supérieur ou égal à 4000 grammes. L'objectif de cette étude est de déterminer la fréquence de la macrosomie, d'identifier les facteurs étiologiques et d’évaluer le pronostic maternel et périnatal. Méthodes Il s'agit d'une étude cas-témoins menéeau sein des maternités de 10 hôpitaux généraux de référence de la ville de Lubumbashi en République Démocratique du Congoentre le 1er décembre 2013 et le 31 mars 2014. Les accouchées ont été réparties en deux groupes, en fonction du poids de naissance de leurs nouveau-nés: groupe I (≥4000 grammes ou plus) et groupe II (2500 à 3500 grammes). Les caractéristiques maternelles, l'environnement obstétrical ainsi que le pronostic maternel et périnatal ont été étudiés et comparés dans les deux groupes. Les données ont été analysées à l'aide du logiciel Épi info version 7.1. Les différences étaient jugées significatives pour un seuil de p<0,05. Résultats Au total, 668 mères et leurs nouveau-nés ont été inclus dont 167 macrosomes et 501témoins. L'incidence de la macrosomie fœtale était de 5,7%. Comparativement aux mères de témoins, nous avons trouvé que les mères des nouveau-nés macrosomes étaient plus âgées, multipares, multigestes, obèses, diabétiques et avaient antérieurement donné naissance à un macrosome. Les taux de césarienne et de délivrance pathologique étaient significativement élevés chez les mères de macrosomes que chez celles de témoins. Lesexe masculin était significativement plus prédominant chez macrosomes que chez les témoins. La dystocie des épaules étaitenregistrée uniquement dans le groupe des macrosomes. Conclusion La prévalence de l'accouchement d'un macrosome à Lubumbashi est de 5,7%. La macrosomie est souvent à l'origine de complications maternelles et périnatales. La réduction de ces dernières passe par une meilleure connaissance des facteurs de risque et un dépistage précoce.
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Affiliation(s)
- Prosper Kakudji Luhete
- Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Olivier Mukuku
- Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Patrick Mubinda Kiopin
- Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Albert Mwembo Tambwe
- Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
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111
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Xu Z, Wen Z, Zhou Y, Li D, Luo Z. Inadequate weight gain in obese women and the risk of small for gestational age (SGA): a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2016; 30:357-367. [PMID: 27033234 DOI: 10.3109/14767058.2016.1173029] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To examine the association between small for gestational age (SGA) and inadequate gestational weight gain (GWG) in obese women (compared with Institute of Medicine [IOM] guidelines) stratified by obesity classes. METHODS We conducted a meta-analysis of original researches with sufficient information about inadequate GWG in obese women stratified by obesity classes. SGA as the chief outcome was extracted and assessed in our analysis. MEDLINE and EMBASE were searched through Ovid from 28 May 2009 to 1 December 2015. Quality was assessed using a modified Newcastle-Ottawa scale. RESULTS 480 citations were screened and 13 studies (437 512 obese women) were included. Obese women who gained weight below the guidelines had higher risks of SGA than those who gained weight within the guidelines (OR 1.28; 95% CI 1.14-1.43). The same conclusions were also confirmed in Class I, Class II and Class III of obese women: Class I (OR 1.37; 95% CI 1.22-1.54); Class II (OR 1.38; 95% CI 1.24-1.54); Class III (OR 1.25; 95% CI 1.14-1.36). CONCLUSIONS From our analysis, the guidelines of IOM can be applied to all the classes of obesity. More accurate boundaries for each obesity class should be established to evaluate the maternal and fetal risks. Diverse populations are thus necessary for more studies in the future.
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Affiliation(s)
- Zhou Xu
- a The College of Clinical Medicine, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Zhenxing Wen
- a The College of Clinical Medicine, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Yuhan Zhou
- b The College of Clinical Pediatrics, Chongqing Medical University , Chongqing , China
| | - Duanhua Li
- c Sichuan Industrial Institute of Antibiotics, Chengdu University , Chengdu , China
| | - Zhongli Luo
- d Molecular Medicine and Cancer Research Center, Chongqing Medical University , Chongqing , China , and.,e The College of Basic Medical Sciences, Chongqing Medical University , Chongqing , China
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112
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Chiavaroli V, Castorani V, Guidone P, Derraik JGB, Liberati M, Chiarelli F, Mohn A. Incidence of infants born small- and large-for-gestational-age in an Italian cohort over a 20-year period and associated risk factors. Ital J Pediatr 2016; 42:42. [PMID: 27117061 PMCID: PMC4845339 DOI: 10.1186/s13052-016-0254-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We assessed the incidence of infants born small-for-gestational-age (SGA) and large-for-gestational-age (LGA) in an Italian cohort over 20 years (1993-2013). Furthermore, we investigated maternal factors associated with SGA and LGA births. METHODS A retrospective review of obstetric records was performed on infants born in Chieti (Italy) covering every 5(th) year over a 20-year period, specifically examining data for 1993, 1998, 2003, 2008, and 2013. Infants with birthweight <10(th) percentile were defined as SGA, and those with birthweight >90(th) percentile as LGA. Data collected included newborn anthropometry, birth (multiple vs singleton), maternal anthropometry, previous miscarriage, gestational diabetes, hypertension, and smoking during pregnancy. RESULTS There were a pooled total of 5896 live births recorded across the 5 selected years. The number of SGA (+60.6 %) and LGA (+90.2 %) births increased considerably between 1993 and 2013. However, there were no marked changes in the incidence of SGA or LGA births (8.3 % and 10.8 % in 1993 versus 7.6 % and 11.7 % in 2013, respectively). Maternal factors associated with increased risk of SGA infants included hypertension, smoking, and previous miscarriage (all p < 0.05), while greater pre-pregnancy BMI and gestational diabetes were risk factors for LGA births (all p < 0.05). CONCLUSIONS There was an increase in the number of SGA and LGA births in Chieti over the last two decades, but there was little change in incidence over time. Most maternal factors associated with increased odds of SGA and LGA births were modifiable, thus incidence could be reduced by targeted interventions.
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Affiliation(s)
- Valentina Chiavaroli
- Department of Paediatrics, University of Chieti, Via dei Vestini 5, 66100, Chieti, Italy. .,Center of Excellence on Aging, "G. d'Annunzio" University Foundation, University of Chieti, Chieti, Italy.
| | - Valeria Castorani
- Department of Paediatrics, University of Chieti, Via dei Vestini 5, 66100, Chieti, Italy
| | - Paola Guidone
- Department of Paediatrics, University of Chieti, Via dei Vestini 5, 66100, Chieti, Italy
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Marco Liberati
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Francesco Chiarelli
- Department of Paediatrics, University of Chieti, Via dei Vestini 5, 66100, Chieti, Italy.,Center of Excellence on Aging, "G. d'Annunzio" University Foundation, University of Chieti, Chieti, Italy
| | - Angelika Mohn
- Department of Paediatrics, University of Chieti, Via dei Vestini 5, 66100, Chieti, Italy.,Center of Excellence on Aging, "G. d'Annunzio" University Foundation, University of Chieti, Chieti, Italy
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113
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Abstract
Gestational diabetes mellitus (GDM) is an increasingly common obstetrical problem. Due to the global escalation in the prevalence of obesity, as many as 15 % of pregnant women may soon be classified as having GDM. While often not diagnosed until late gestation, GDM is now recognized as a disorder of glucose and lipid metabolism, systemic inflammation, and insulin resistance that begins early in pregnancy. Recent large randomized trials have clarified the risk of maternal and neonatal complications caused by GDM, as well as the potential to ameliorate these risks. There is significant interest in the potential to reduce the risk for developing GDM in obese women through the performance of bariatric surgery (BS) before pregnancy. BS significantly reduces the risk for GDM, preeclampsia, and large neonates. However, it seems that the risk for small neonates and preterm delivery is increased. No significant differences are observed in regard to cesarean section, postpartum hemorrhage, or perinatal mortality. In this article, we address the effects of GDM on the mother and child, and explore the risks and benefits of BS in the obstetrical population.
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Affiliation(s)
- Kent Willis
- Our Lady of the Lake Children's Hospital, 7777 Hennessy Boulevard, Suite 6003, Baton Rouge, LA, 70808, USA.
| | - Charlotte Alexander
- The Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 151, Beer-Sheva, Israel.
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114
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Mason SM, Tobias DK, Clark CJ, Zhang C, Hu FB, Rich-Edwards JW. Abuse in Childhood or Adolescence and Gestational Diabetes: A Retrospective Cohort Study. Am J Prev Med 2016; 50:436-444. [PMID: 26547539 PMCID: PMC4801767 DOI: 10.1016/j.amepre.2015.08.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/05/2015] [Accepted: 08/25/2015] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Early life abuse has been linked to later Type 2 diabetes, but its association with gestational diabetes has not been examined. The aim of this study was to examine the association between childhood and adolescent abuse victimization and risk of gestational diabetes in the Nurses' Health Study II. METHODS Participants were asked about experiences of physical and sexual abuse in childhood or adolescence in 2001 and about history of pregnancy complications in 2009. Mothers of singleton live births who provided information on their abuse history comprised the study sample. Modified Poisson regression was used to estimate risk ratios and 95% CIs for gestational diabetes as a function of physical and sexual abuse victimization. Analyses were conducted in 2014-2015. RESULTS Of 45,550 women in the analysis, 8% reported severe physical abuse and 11% reported forced sexual activity in childhood or adolescence. Approximately 3% (n=3,181) of pregnancies were complicated by gestational diabetes. In adjusted models, severe physical abuse was associated with a 42% greater gestational diabetes risk (risk ratio=1.42, 95% CI=1.21, 1.66) relative to no physical abuse. Forced sexual activity was associated with a 30% greater risk (95% CI=1.14, 1.49). Women with histories of both physical and sexual abuse were at higher risk than women exposed to a single type of abuse. These associations were not explained by overweight status in early adulthood or prior to pregnancy. CONCLUSIONS Childhood and adolescent victimization is associated with increased risk of gestational diabetes in adult women.
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Affiliation(s)
- Susan M Mason
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Deirdre K Tobias
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Cari J Clark
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Department of Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Cuilin Zhang
- Epidemiology Branch, Division of Intramural Population Health Research, National Institute of Child Health and Development, Bethesda, Maryland
| | - Frank B Hu
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Janet W Rich-Edwards
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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115
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Abstract
Estimation of fetal weight is an important component of antenatal and intrapartum management of pregnant women. While many clinicians use ultrasound estimates of fetal weight to assess fetal growth, there are inherent challenges in both the diagnosis and management of suspected fetal macrosomia. Given the inaccuracy in estimating fetal weight, and the risks that accompany cesarean birth or induction of labor, the management of suspected fetal macrosomia requires open communication and shared decision making between the woman and her health care providers. This case study and literature review highlight the current management and recommendations for suspected fetal macrosomia.
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116
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Pregnancy adverse outcomes related to pregravid body mass index and gestational weight gain, according to the presence or not of gestational diabetes mellitus: A retrospective observational study. DIABETES & METABOLISM 2016; 42:38-46. [DOI: 10.1016/j.diabet.2015.06.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 06/01/2015] [Accepted: 06/02/2015] [Indexed: 12/13/2022]
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117
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Narayanan RP, Weeks AD, Quenby S, Rycroft D, Hart A, Longworth H, Charnley M, Abayomi J, Topping J, Turner MA, Wilding JPH. Fit for Birth - the effect of weight changes in obese pregnant women on maternal and neonatal outcomes: a pilot prospective cohort study. Clin Obes 2016; 6:79-88. [PMID: 26781604 DOI: 10.1111/cob.12129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 11/15/2015] [Accepted: 11/19/2015] [Indexed: 01/15/2023]
Abstract
UNLABELLED The 'Fit for Birth' study aimed to explore patterns of gestational weight gain and their relationship with pregnancy outcomes. The study had three aims: 1. To explore the feasibility of conducting a large cohort study in this setting. 2. To describe patterns of weight gain through pregnancy in obese women. 3. To explore associations of weight change during pregnancy with outcomes. STUDY POPULATION Pregnant women with a BMI ≥ 30 kg m(-2) at first antenatal clinic visit. METHODS This was a single centre pilot observational study based at the Liverpool Women's Hospital, a large UK maternity hospital.Women were recruited into the study at their antenatal booking visit and had weights measured throughout pregnancy. Patterns of weight gain were described and related to maternal and neonatal outcomes. MAIN OUTCOME MEASURE The primary outcome was a composite measure consisting of any of 12 adverse maternal and foetal outcomes. This was compared by categorized pregnancy weight gain (<0 kg, 0-5 kg, 5.1-9 kg and >9 kg). RESULTS Eight hundred and twenty four women consented to participation between June 2009 and June 2010. Weight data were collected on 756 women. Only 385 women had weights measured in all three study assessment periods (6-20 weeks, 20 + 1 to 32 weeks and >32 weeks gestation) while 427 women had weights measured in period 3. Individual patterns of weight gain varied widely and missing data were common and non-random. There was a significant association between increased weight gain during pregnancy and poor maternal and foetal outcome. CONCLUSIONS Weight gain in obese women during pregnancy can be highly variable. Our study supports an association between increased weight gain in pregnancy and adverse perinatal outcomes.
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Affiliation(s)
- R P Narayanan
- Department of Obesity and Endocrinology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - A D Weeks
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - S Quenby
- Biomedical Research Unit in Reproductive Health, University of Warwick, Coventry, UK
| | - D Rycroft
- Fit for Birth, School of Reproductive and Developmental Medicine, Liverpool Women's Hospital, Liverpool, UK
| | - A Hart
- Lancaster Medical School, Clinical Research Hub, Lancaster University, Lancaster, Lancashire, UK
| | - H Longworth
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - M Charnley
- Faculty of Education, Health & Community, Liverpool John Moores University, Liverpool, UK
| | - J Abayomi
- Faculty of Education, Health & Community, Liverpool John Moores University, Liverpool, UK
| | - J Topping
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - M A Turner
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - J P H Wilding
- Department of Obesity and Endocrinology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
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118
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Van Der Linden EL, Browne JL, Vissers KM, Antwi E, Agyepong IA, Grobbee DE, Klipstein-Grobusch K. Maternal body mass index and adverse pregnancy outcomes: A ghanaian cohort study. Obesity (Silver Spring) 2016; 24:215-22. [PMID: 26574712 DOI: 10.1002/oby.21210] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine the association between maternal weight at <17 weeks gestation and maternal and infant outcomes of pregnancy, delivery, and the postpartum period in pregnant Ghanaian women. METHODS A prospective cohort study of 1,000 women in Accra, Ghana (2012-2014), was conducted. Women were classified as having overweight (BMI 25-30) and obesity (BMI ≥ 30), and their obstetric and infant outcomes were analyzed using multivariate logistic regression. RESULTS The analysis included 824 women, average 28 years (SD 5.1); 313 (31.3%) had overweight and 169 (16.9%) obesity. Women with obesity had a two-fold increased risk for cesarean sections (RR 2.20, 95% CI 1.21-4.02) and more than a six-fold higher risk for pregnancy-induced hypertension (RR 6.17, 95% CI 2.90-13.13) and chronic hypertension (RR 6.00, 95% CI 1.40-25.76). Infants of women with overweight or obesity were more likely to be macrosomic (RR 2.37, 95% CI 1.13-4.97). CONCLUSIONS The global obesity epidemic has reached women in low- and middle-income countries (LMIC) with important adverse consequences for maternal and infant health. Antenatal care in LMIC will need to anticipate this potential expansion of complications, including the development of guidelines for optimal maternity care for pregnant women with overweight and obesity.
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Affiliation(s)
- Eva L Van Der Linden
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Karin M Vissers
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
- Gelderse Vallei Hospital, Ede, The Netherlands
| | - Edward Antwi
- Ghana Health Service, Greater Accra Region, Ghana
| | | | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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120
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El Rafei R, Abbas HA, Charafeddine L, Nakad P, Al Bizri A, Hamod D, Yunis KA. Association of Pre-Pregnancy Body Mass Index and Gestational Weight Gain with Preterm Births and Fetal Size: an Observational Study from Lebanon. Paediatr Perinat Epidemiol 2016; 30:38-45. [PMID: 26469281 DOI: 10.1111/ppe.12249] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are reported to impact the preterm birth (PTB) rate and newborn size. Most studies have been conducted in developed countries, although PTB and adverse pregnancy outcomes are more frequent in the developing world. The aim of this study is to elucidate the association of pre-pregnancy BMI and GWG on the occurrence of PTB and sub-optimal fetal size in Lebanon. METHODS This is a retrospective cohort study using a hospital-based register covering 35% of births in Lebanon between 2001 and 2012. Data were collected on 170 428 pregnancies from 32 hospitals using medical records and interviews. RESULTS After adjusting for confounders, underweight women had increased odds of having very preterm [odds ratio (OR) 1.58, 95% confidence interval (CI) 1.16, 2.14], preterm (OR 1.42, 95% CI 1.28, 1.58), and small for gestational age (SGA) (OR 1.50, 95% CI 1.37, 1.63) neonates. When BMI was analysed with GWG, only SGA remained significant in underweight women with low GWG. For all BMI groups, low GWG was protective against large for gestational age (LGA) and high GWG increased the odds of LGA. GWG, both low (OR 1.25, 95% CI 1.15, 1.35) and high (OR 1.43, 95% CI 1.32, 1.55) increased the risk of PTB in normal weight women. The same result was obtained for overweight women. CONCLUSIONS High GWG increased the risk of LGA for all groups and PTB in normal weight and overweight women, whereas low GWG increased the risk of SGA and PTB. Given that there are not many studies from middle income/developing countries on patterns of weight gain during pregnancy, findings from this study may help with pre-conception counselling with emphasis on the importance of an optimal pre-pregnancy BMI and appropriate weight gain during pregnancy.
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Affiliation(s)
- Rym El Rafei
- Pediatrics and Adolescent Medicine, Neonatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein A Abbas
- Pediatrics and Adolescent Medicine, Neonatology, American University of Beirut Medical Center, Beirut, Lebanon.,University of Texas MD Anderson Center, Houston, Texas, USA
| | - Lama Charafeddine
- Pediatrics and Adolescent Medicine, Neonatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Pascale Nakad
- Pediatrics and Adolescent Medicine, Neonatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ayah Al Bizri
- Pediatrics and Adolescent Medicine, Neonatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dany Hamod
- Pediatrics and Adolescent Medicine, Neonatology, Saint Georges Hospital-University of Balamand, Beirut, Lebanon
| | - Khalid A Yunis
- Pediatrics and Adolescent Medicine, Neonatology, American University of Beirut Medical Center, Beirut, Lebanon
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Zilberlicht A, Feferkorn I, Younes G, Damti A, Auslender R, Riskin-Mashiah S. The mutual effect of pregestational body mass index, maternal hyperglycemia and gestational weight gain on adverse pregnancy outcomes. Gynecol Endocrinol 2016; 32:416-20. [PMID: 27052494 DOI: 10.3109/09513590.2015.1127911] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the mutual effect of obesity, gestational diabetes (GDM) and gestational weight gain (GWG) on adverse pregnancy outcomes. METHODS Charts of patients who delivered in our hospital between June 2001 and June 2006 singleton, live births >24 weeks gestation were reviewed. Univariate and multivariate logistic regression were used to assess pregnancy outcomes defined as large for gestational age (LGA), primary cesarean section (PCS) and a composite outcome of LGA and/or PCS. RESULTS A total of 8595 women were included. Frequency of composite outcome increased with increasing body mass index (BMI), increasing hyperglycemia and above-recommended GWG. In the multivariate logistic regression analysis compared to women with normal BMI, odds ratio (OR) for composite outcome was 1.23 (95% confidence interval [CI] 1.06-1.44) in overweight women, OR = 1.86 (1.51-2.31) in obese women and in severe obesity OR = 2.97 (2.15-4.11). Compared to normoglycemic women, odds for composite outcome in women with abnormal glucose challenge test OR = 1.46 (1.20-1.79), impaired glucose tolerance OR = 1.65 (1.14-2.4) and GDM OR = 1.56 (1.16-2.10). Women with GWG above recommended had OR = 1.58, (1.37-1.81) for composite outcome. CONCLUSIONS Higher pregestational BMI, maternal hyperglycemia and above-recommended GWG independently contribute to adverse pregnancy outcomes. Furthermore, there is mutual effect between these three factors and adverse outcomes. Appropriate pregestational weight and adequate GWG might reduce risk of adverse pregnancy outcomes.
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Affiliation(s)
- Ariel Zilberlicht
- a Department of Obstetrics and Gynecology , the Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel
| | - Ido Feferkorn
- a Department of Obstetrics and Gynecology , the Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel
| | - Grace Younes
- a Department of Obstetrics and Gynecology , the Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel
| | - Amit Damti
- a Department of Obstetrics and Gynecology , the Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel
| | - Ron Auslender
- a Department of Obstetrics and Gynecology , the Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel
| | - Shlomit Riskin-Mashiah
- a Department of Obstetrics and Gynecology , the Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel
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122
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Ashwal E, Hod M. Gestational diabetes mellitus: Where are we now? Clin Chim Acta 2015; 451:14-20. [DOI: 10.1016/j.cca.2015.01.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 01/24/2015] [Accepted: 01/24/2015] [Indexed: 01/17/2023]
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Maury E, Savel J, Grouthier V, Rajaobelina K, Corvo L, Lorrain S, Gonzalez C, Gin H, Barberger-Gateau P, Rigalleau V. Is skin autofluorescence a marker of metabolic memory in pregnant women with diabetes? Diabet Med 2015; 32:1575-9. [PMID: 25981634 DOI: 10.1111/dme.12803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2015] [Indexed: 12/30/2022]
Abstract
AIM To determine whether skin autofluorescence can help to detect those who have previously had abnormal glucose levels among women referred for diabetes during pregnancy. METHODS Using an advanced glycation end product reader (AGE Reader(tm) (;) DiagnOptics BV, Groningen, the Netherlands), we measured forearm skin autofluorescence at 24-30 weeks of gestation in all women who were referred to our Nutrition Diabetology unit for diabetes during pregnancy. RESULTS The study included 230 women (200 with gestational diabetes and 30 with pre-gestational diabetes, of whom 21 had Type 1 and nine had Type 2 diabetes) and a reference group of 22 normoglycaemic non-pregnant women. Skin autofluorescence was significantly higher in women with pre-gestational diabetes (1.97 ± 0.44 arbitary units) compared with gestational diabetes (1.77 ± 0.32 arbitary units; P = 0.003) and lower in the reference group (1.60 ± 0.32 arbitary units; P = 0.009 vs all pregnant women). Among women with gestational diabetes, 71 had a history of hyperglycaemia (i.e. gestational diabetes or macrosomia in a previous pregnancy or discovery of diabetes before 24th gestational week in the present pregnancy). These women had higher levels of skin autofluorescence (1.83 ± 0.35 arbitary units) than women with gestational diabetes without previous history of hyperglycaemia (1.73 ± 0.30 arbitary units; P = 0.04, non-significant, adjusted for age). Skin autofluorescence increased with the number of criteria present for previous hyperglycaemia (P for trend = 0.008) and was significantly associated with having two or three criteria for hyperglycaemia after adjusting for age (P = 0.02). CONCLUSIONS Skin autofluorescence could reflect previous long-term hyperglycaemia in pregnant women, and could therefore be a marker of metabolic memory.
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MESH Headings
- Adult
- Biomarkers/metabolism
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/metabolism
- Diabetes, Gestational/blood
- Diabetes, Gestational/epidemiology
- Diabetes, Gestational/metabolism
- Female
- Fluorescence
- Forearm
- France/epidemiology
- Fructosamine/blood
- Glycated Hemoglobin/analysis
- Glycation End Products, Advanced/metabolism
- Humans
- Pregnancy
- Pregnancy Trimester, Second
- Pregnancy Trimester, Third
- Pregnancy in Diabetics/blood
- Pregnancy in Diabetics/metabolism
- Recurrence
- Risk
- Skin/metabolism
- Spectrometry, Fluorescence
- Up-Regulation
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Affiliation(s)
- E Maury
- Nutrition Diabetology Unit, CHU Bordeaux, Haut Lévèque Hospital, Pessac, France
- University of Bordeaux, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
| | - J Savel
- Nutrition Diabetology Unit, CHU Bordeaux, Haut Lévèque Hospital, Pessac, France
| | - V Grouthier
- Department of Gynaecology, CHU Bordeau, Pellegrin Hospital, Bordeaux, France
| | - K Rajaobelina
- University of Bordeaux, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
| | - L Corvo
- Nutrition Diabetology Unit, CHU Bordeaux, Haut Lévèque Hospital, Pessac, France
| | - S Lorrain
- University of Bordeaux, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
| | - C Gonzalez
- Nutrition Diabetology Unit, CHU Bordeaux, Haut Lévèque Hospital, Pessac, France
| | - H Gin
- Nutrition Diabetology Unit, CHU Bordeaux, Haut Lévèque Hospital, Pessac, France
| | - P Barberger-Gateau
- University of Bordeaux, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
| | - V Rigalleau
- Nutrition Diabetology Unit, CHU Bordeaux, Haut Lévèque Hospital, Pessac, France
- University of Bordeaux, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
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Vilchez GA, Dai J, Hoyos LR, Gill N, Bahado-Singh R, Sokol RJ. Labor and neonatal outcomes after term induction of labor in gestational diabetes. J Perinatol 2015; 35:924-9. [PMID: 26313053 DOI: 10.1038/jp.2015.103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 07/11/2015] [Accepted: 07/22/2015] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To identify the optimal gestational age (GA) for induction of labor (IOL) at term among patients with gestational diabetes (GDMA) according to perinatal outcomes. STUDY DESIGN The US Natality Database from 2007 to 2010 was reviewed. Inclusion criteria were singleton delivery, IOL at 37 to 42 weeks and GDMA. Exclusion criteria included congenital anomalies, pre-gestational diabetes, hypertensive disorders, previous cesarean, breech presentation and rupture of membranes. Controls were non-GDMA cases delivered in geographic and temporal proximity. Delivery mode, macrosomia and perinatal complications were analyzed. Logistic regression adjusted for confounders was used to calculate odds ratios by GA using 39 weeks non-GDMA as reference. RESULTS In all, 96,964 cases and 176,079 controls were included. Increased risk for all adverse outcomes among GDMA cases was found. The nadir for intrapartum and neonatal complications was 38 and 40 weeks, respectively, whereas for cesarean and macrosomia was 39 weeks. CONCLUSION The optimal timing for IOL at term in GDMA appears to be 39 to 40 weeks.
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Affiliation(s)
- G A Vilchez
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - J Dai
- C.S Mott Center for Human Growth and Development, Wayne State University, Detroit, MI, USA
| | - L R Hoyos
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - N Gill
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - R Bahado-Singh
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - R J Sokol
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
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125
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Psychosocial factors and excessive gestational weight gain: The effect of parity in an Australian cohort. Midwifery 2015; 32:30-7. [PMID: 26476510 DOI: 10.1016/j.midw.2015.09.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/13/2015] [Accepted: 09/21/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVES psychosocial variables can be protective or risk factors for excessive gestational weight gain (GWG). Parity has also been associated with GWG; however, its effect on psychosocial risk factors for GWG is yet to be determined. The aim of this study was to investigate if, and how, psychosocial factors vary in their impact on the GWG of primiparous and multiparous women. DESIGN/PARTICIPANTS pregnant women were recruited in 2011 via study advertisements placed in hospitals, online, in parenting magazines, and at baby and children's markets, resulting in a sample of 256 women (113 primiparous, 143 multiparous). Participants completed questionnaires at 16-18 weeks' gestation and their pregravid BMI was recorded. Final weight before delivery was measured and used to calculate GWG. FINDINGS the findings revealed that primiparous women had significantly higher feelings of attractiveness (a facet of body attitude; p=0.01) than multiparous women. Hierarchical regressions revealed that in the overall sample, increased GWG was associated significantly with lower pre-pregnancy BMI (standardised coefficient β=-0.39, p<0.001), higher anxiety symptoms (β=0.25, p=0.004), and reduced self-efficacy to eat a healthy diet (β=-0.20, p=0.02). Although higher GWG was predicted significantly by decreased feelings of strength and fitness for primiparous women (β=-0.25, p=0.04) and higher anxiety was related significantly to greater GWG for multiparous women (β=0.43, p<0.001), statistical comparison of the model across the two groups suggested the magnitude of these effects did not differ across groups (p>0.05). CONCLUSIONS/IMPLICATIONS FOR PRACTICE the findings suggest that psychosocial screening and interventions by healthcare professionals may help to identify women who are at risk of excessive GWG, and there may be specific psychosocial factors that are more relevant for each parity group.
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Yang S, Zhou A, Xiong C, Yang R, Bassig BA, Hu R, Zhang Y, Yao C, Zhang Y, Qiu L, Qian Z, Trevathan E, Flick L, Xu S, Wang Y, Xia W, Zheng T, Zhang B. Parental Body Mass Index, Gestational Weight Gain, and Risk of Macrosomia: a Population-Based Case-Control Study in China. Paediatr Perinat Epidemiol 2015; 29:462-71. [PMID: 26228295 DOI: 10.1111/ppe.12213] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The prevalence of macrosomia has risen markedly worldwide, including in China, during the past two decades. Few epidemiological studies, however, have investigated the risk factors for macrosomia in China. This study was designed to investigate the associations between parental anthropometric characteristics, gestational weight gain (GWG), and risk of macrosomia in China. METHODS This population-based, case-control study in Wuhan, China, included a total of 6341 subjects (870 cases and 5471 controls). Multivariable logistic regression was conducted to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Mothers or fathers who were overweight or obese before pregnancy had an elevated risk of giving birth to a macrosomic infant compared with their normal weight counterparts. Women with GWG above the Institute of Medicine (IOM) recommendation had an adjusted OR of 6.09 [95% CI 5.04, 7.35] for delivering a macrosomic infant compared with women who had GWG within the IOM recommendation. When stratified by maternal pre-pregnancy body mass index (BMI), women who were underweight or normal weight before pregnancy were observed to have a higher risk of macrosomia birth associated with greater GWG. CONCLUSIONS Parental pre-pregnancy overweight/obesity and excessive GWG during pregnancy were highly associated with macrosomia. The association with GWG was most pronounced in mothers who had a normal or underweight pre-pregnancy BMI. Weight control efforts before pregnancy for mothers and fathers as well as control of maternal gain during pregnancy may reduce the risk of macrosomia.
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Affiliation(s)
- Shaoping Yang
- Healthcare Department, Wuhan Women and Children Medical and Healthcare Center, Wuhan, Hubei, China
| | - Aifen Zhou
- Healthcare Department, Wuhan Women and Children Medical and Healthcare Center, Wuhan, Hubei, China
| | - Chao Xiong
- Healthcare Department, Wuhan Women and Children Medical and Healthcare Center, Wuhan, Hubei, China
| | - Rong Yang
- Healthcare Department, Wuhan Women and Children Medical and Healthcare Center, Wuhan, Hubei, China
| | - Bryan A Bassig
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Ronghua Hu
- Healthcare Department, Wuhan Women and Children Medical and Healthcare Center, Wuhan, Hubei, China
| | - Yiming Zhang
- Healthcare Department, Wuhan Women and Children Medical and Healthcare Center, Wuhan, Hubei, China
| | - Cong Yao
- Healthcare Department, Wuhan Women and Children Medical and Healthcare Center, Wuhan, Hubei, China
| | - Yaqi Zhang
- Healthcare Department, Wuhan Women and Children Medical and Healthcare Center, Wuhan, Hubei, China
| | - Lin Qiu
- Healthcare Department, Wuhan Women and Children Medical and Healthcare Center, Wuhan, Hubei, China
| | - Zhengmin Qian
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO
| | - Edwin Trevathan
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO
| | - Louise Flick
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO
| | - Shunqing Xu
- Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Youjie Wang
- Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wei Xia
- Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tongzhang Zheng
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Bin Zhang
- Healthcare Department, Wuhan Women and Children Medical and Healthcare Center, Wuhan, Hubei, China
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Derraik JGB, Ayyavoo A, Hofman PL, Biggs JB, Cutfield WS. Increasing maternal prepregnancy body mass index is associated with reduced insulin sensitivity and increased blood pressure in their children. Clin Endocrinol (Oxf) 2015; 83:352-6. [PMID: 25388277 DOI: 10.1111/cen.12665] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/17/2014] [Accepted: 11/06/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We aimed to assess the effects of maternal prepregnancy body mass index (BMI) on insulin sensitivity, metabolism and blood pressure in the offspring. METHODS We studied 70 prepubertal children aged 8·9 ± 1·9 years (range 4-11 years), born 38-40 weeks of gestation and appropriate-for-gestational-age birthweight. Maternal prepregnancy body mass index (MPP BMI) was calculated from self-reported weight. Children's insulin sensitivity was measured using intravenous glucose tolerance tests and Bergman's minimal model. Other clinical assessments included auxology, fasting lipid and hormonal profiles, DXA-derived body composition and 24-h ambulatory blood pressure monitoring. Data were analysed using random effect mixed models, adjusting for important confounders and a random factor to account for sibling clusters. RESULTS Increasing MPP BMI was correlated with increasing BMI standard deviation scores (SDS) (r = 0·30; P = 0·012) and lower insulin sensitivity in their children (r = -0·34; P = 0·004). In multivariate regression models, increasing MPP BMI was associated with lower insulin sensitivity (β = -0·040; P = 0·005), with every 1 kg/m(2) increase in MPP BMI associated with a 4·0% decrease in offspring insulin sensitivity. Greater MPP BMI was associated with higher systolic blood pressure in the daytime (β = 0·794; P = 0·010) and night-time (β = 0·800; P = 0·017), as well as higher 24-h mean arterial pressure (β = 0·508; P = 0·025) in the offspring. CONCLUSION Greater maternal prepregnancy BMI is associated with lower insulin sensitivity and higher blood pressure in their children, effects that were independent of offspring adiposity. Thus, higher maternal BMI prior to pregnancy (even among women of normal BMI) may contribute to increased risk of type 2 diabetes and other metabolic diseases in the subsequent generation.
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Affiliation(s)
- José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Ahila Ayyavoo
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Gravida: National Centre for Growth and Development, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Gravida: National Centre for Growth and Development, Auckland, New Zealand
| | - Janene B Biggs
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Gravida: National Centre for Growth and Development, Auckland, New Zealand
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128
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Khorshidi Roozbahani R, Geranmayeh M, Hantoushzadeh S, Mehran A. Effects of telephone follow-up on blood glucose levels and postpartum screening in mothers with Gestational Diabetes Mellitus. Med J Islam Repub Iran 2015; 29:249. [PMID: 26793640 PMCID: PMC4715405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 03/05/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a form of diabetes that occurs in pregnancy. GDM, defined as glucose intolerance, first diagnosed or initiated during pregnancy affects 1-14% of pregnancies based on various studies. Screening and early diagnosis and appropriate glycemic control can improve prenatal outcomes. Telephone follow-up seems to be a reasonable way for pregnant women follow-up. The present study evaluated the effects of telephone follow-up on blood glucose level during pregnancy and postpartum screening. METHODS Eighty mothers with GDM were enrolled in this clinical trial and randomly divided into intervention and control groups. All mothers were asked to check their blood sugar levels fivetimes daily. In intervention group, telephone intervention was performed for 10 weeks. In each follow-up, individuals were followed for insulin injections, diet, clinical tests and reminding the next visit. In control group, three times of telephone call was established to record blood sugar levels. Another telephone call was established at 6 weeks of postpartum in both study groups to evaluate the performance of the screening test for blood sugar. RESULTS The mean age of mothers was 30.9±5 years in the control and 30.7±5.1 years in the intervention groups In intervention group, mean level of blood glucose, 2 hours after lunch at 28 weeks of pregnancy was significantly lower than the control group (P<0.05). Mean differences in levels of fasting blood glucose between 28 weeks and 32 and between 28 and 36 weeks of pregnancy were significantly higher in the intervention than the control group (P<0.05). Rate of postpartum glucose screening test was significantly higher in the intervention group (P<0.001). CONCLUSION The findings of this study demonstrated that telephone follow-up could significantly reduce fasting blood glucose levels in mothers with gestational diabetes and also increased the rate of postpartum screening test.
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Affiliation(s)
- Rezvan Khorshidi Roozbahani
- 1 MSc of Midwifery, Department of Midwifery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mehrnaz Geranmayeh
- 2 PhD student of Medical Education, Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. ,(Corresponding author) PhD student of Medical Education, Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sedigheh Hantoushzadeh
- 3 MD, Department of Obstetrics and Gynecology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abbas Mehran
- 4 MSc of Biostatistics, Department of Midwifery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
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129
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Excessive weight gain during pregnancy and risk of macrosomia: a meta-analysis. Arch Gynecol Obstet 2015; 293:29-35. [DOI: 10.1007/s00404-015-3825-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 07/21/2015] [Indexed: 01/19/2023]
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130
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Smid MC, Dorman KF, Boggess KA. Lost in translation? English- and Spanish-speaking women's perceptions of gestational weight gain safety, health risks and counseling. J Perinatol 2015; 35:585-9. [PMID: 25836322 DOI: 10.1038/jp.2015.24] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 02/19/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To determine English- and Spanish-speaking women's perceptions on gestational weight gain (GWG) counseling. STUDY DESIGN We administered a written survey to 279 pregnant women regarding GWG counseling and knowledge. We compared English- and Spanish-speaking women's responses using X(2)-tests and logistic regression analyses. RESULT Seventy-four (27%) women completed the survey in Spanish and 205 (73%) in English. More Spanish compared with English speakers did not know if their provider recommended weight gain goals (26% vs 10%, odds ratio (OR) 3.2, confidence interval (CI) 1.5 to 6.5); if there are risks to excessive GWG for mother (27% vs 11%, OR 3.1, CI 1.5 to 6.4) or infant (38% vs 16%, OR 3.3, CI 1.7 to 6.3); or if exercise (15% vs 1%, OR 12.1, CI 3.0 to 69.1) or weight loss (35% v 12%, OR 4.0, CI 2.0 to 8.0) were safe during pregnancy. CONCLUSION Significant differences exist between Spanish- and English-speaking women's perception of GWG counseling, which may be due to language or cultural barriers.
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Affiliation(s)
- M C Smid
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - K F Dorman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - K A Boggess
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
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131
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Nilsson C, Ursing D, Strevens H, Landin-Olsson M. Towards normalized birthweight in gestational diabetes mellitus. Acta Obstet Gynecol Scand 2015; 94:1090-4. [PMID: 26073567 DOI: 10.1111/aogs.12695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 06/03/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The objective was to describe pregnancy outcomes in gestational diabetes mellitus (GDM) in comparison with general population in Sweden. MATERIAL AND METHODS A population-based retrospective study using University hospital records and Swedish Medical Birth Register was carried out on pregnant women with well-monitored GDM (n = 870) and pregnancies in the Swedish Medical Birth Register (n = 1 553 420). Data from GDM pregnancies was compared to pregnancies in the whole of Sweden during 1995-2010. The main outcome measures were age, first bodyweight in and weight gain during pregnancy, birthweight, gestational length, percentage of cesarean deliveries. RESULTS First maternal bodyweight during the GDM pregnancy was higher than in the general population, 72.4 ± 17.4 kg (n = 837) vs. 67.3 ± 12.6 kg (n = 1 383 000; p < 0.0001). Women with GDM gained less weight during pregnancy 9.9 ± 5.8 kg (n = 703) compared to the general population, 13.2 ± 5.7 kg (n = 482 860; p < 0.0001). Mean birthweight in GDM pregnancies was 3564 ± 500 g (n = 743) compared to 3580 ± 483 g for the general population (n = 1 316 364; p = ns). Gestational length was slightly shorter, 39.4 weeks in the GDM pregnancies (n = 683) vs. 39.5 weeks (n = 1 319 876; p = 0.02) in the general population and the percentage of cesarean deliveries higher in the GDM pregnancies at 18.4% (n = 712) vs. 13.3% (n = 1 322 242; p < 0.0001). CONCLUSIONS Though many studies have shown an increased risk of macrosomia in GDM pregnancies, remaining even after ambitious management programs, we show no difference in birthweight. This may be due to a combination of intense efforts to achieve good metabolic control during pregnancy and shorter pregnancy duration. Preventing unduly large babies is crucial to minimize adverse pregnancy outcomes.
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Affiliation(s)
- Charlotta Nilsson
- Department of Pediatrics, Institution of Clinical Science, Helsingborg Hospital, Lund University, Helsingborg, Sweden
| | - Dag Ursing
- Department of Endocrinology, Institution of Clinical Science, Skåne University Hospital, Lund University, Lund, Sweden
| | - Helena Strevens
- Department of Obstetrics and Gynecology, Institution of Clinical Science, Skåne University Hospital, Lund University, Lund, Sweden
| | - Mona Landin-Olsson
- Department of Endocrinology, Institution of Clinical Science, Skåne University Hospital, Lund University, Lund, Sweden
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Abstract
OBJECTIVE To examine the association between weight loss in obese pregnant women and relevant maternal and neonatal outcomes. METHODS All liveborn singleton term (37 weeks of gestation or greater) births in obese women between 2009 and 2011 in Flanders (the northern part of Belgium) were included (N=18,053). Outcomes assessed included gestational hypertension, low (2,500 g or less) birth weight, small-for-gestational-age (less than the 10th percentile) neonates, macrosomia (birth weight 4,000 g or greater), large-for-gestational-age (greater than 90th percentile) neonates, emergency caesarean delivery, and admission to a neonatal intensive care unit. Risk for adverse outcomes was calculated by multiple logistic regression analysis for weight change categories (greater weight loss [5 kg or greater], lesser weight loss [between 0 and 5 kg], low gestational weight gain [0 or greater and less than 5 kg], adequate gestational weight gain [5 or greater to 9 kg or less, reference], and excessive gestational weight gain [greater than 9 kg]) in each obesity class (I 30-34.9, II 35-39.9, III 40 or greater) adjusted for parity and maternal and gestational age. RESULTS In the total population, 854 (4.7%) obese pregnant women reported weight loss. Weight loss and low weight gain were associated with a decreased incidence of gestational hypertension for women with class I obesity (greater weight loss adjusted odds ratio [OR] 0.31, 95% confidence interval [CI] 0.11-0.84; lesser weight loss adjusted OR 0.46 95% CI 0.21-0.99; low gain adjusted OR 0.71 95% CI 0.54-0.93), a reduction in the rate of emergency cesarean delivery, but only in those with class II obesity (greater weight loss adjusted OR 0.24, 95% CI 0.07-0.78; lesser weight loss adjusted OR 0.50, 95% CI 0.26-0.97; low gain adjusted OR 0.55, 95% CI 0.38-0.79), and decreased macrosomia and large-for-gestational-age neonates in women in all classes of obesity, with the highest decrease for women with class III obesity (greater weight loss adjusted OR 0.15, 95% CI 0.05-0.49; lesser weight loss adjusted OR 0.37, 95% CI 0.15-0.90 for macrosomia). No association between weight loss and low birth weight, small-for-gestational-age neonates, or admission to the neonatal intensive care unit was shown in the different obesity classes. CONCLUSION Weight loss in obese pregnant women was associated with reduced perinatal risks but not with the rate of low birth weight or small-for-gestational-age neonates in obese women from class III in this affluent region. Stratification of recommended gestational weight gain ranges in obese women should be considered. LEVEL OF EVIDENCE II.
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133
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Zhang CH, Liu XY, Zhan YW, Zhang L, Huang YJ, Zhou H. Effects of Prepregnancy Body Mass Index and Gestational Weight Gain on Pregnancy Outcomes. Asia Pac J Public Health 2015; 27:620-30. [DOI: 10.1177/1010539515589810] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To investigate the single and joint effects of prepregnancy body mass index (BMI) and gestational weight gain (GWG) on pregnancy outcomes, electronic medical records of 14 196 women who delivered singleton live infant at a maternal and child health hospital in Beijing, China, in 2012 were reviewed. Logistic regression was used to assess the associations, adjusting for maternal age, height, education, parity, and offspring sex. Women of high prepregnancy BMI or excessive GWG had higher risks of gestational diabetes mellitus, hypertensive disorders in pregnancy, postpartum hemorrhage, caesarean delivery, macrosomia, and large for gestational age infant, while women of inadequate GWG had higher risks of preterm delivery, low birth weight, and small for gestational age infant. Findings suggest that antenatal care providers should help pregnant women control their GWG to normal.
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Affiliation(s)
| | - Xiang Yu Liu
- University of Texas Health Science Center, Houston, TX, USA
| | | | - Long Zhang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yan Jie Huang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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134
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Tsitas M, Schmid BC, Oehler MK, Tempfer CB. Macrosomic and low birth weight neonates in Pacific Islanders from Samoa: a case-control study. Arch Gynecol Obstet 2015; 292:1261-6. [PMID: 26044149 DOI: 10.1007/s00404-015-3773-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND To assess the perinatal morbidity and mortality of macrosomic (>4500 g) and low birth weight (LBW) (<2500 g) neonates in a Pacific Islander population (PIP) from Samoa compared to a Caucasian population (CP). METHODS Case-control study. Clinical data were extracted by chart review. RESULTS In 3166 (PIP) and 2101 (CP) deliveries, macrosomia was more prevalent and LBW less prevalent in the PIP [76/3166 (2.4 %) vs. 21/2101 (0.9 %); p < 0.0001 and 149/3166 (4.7 %) vs. 163/2101 (7.7 %); p < 0.0001, respectively]. Among macrosomic neonates, perinatal mortality and composite severe neonatal morbidity (CNM) were higher in the PIP compared to the CP [2/76 (3 %) vs. 0/21 (0 %) and 6/76 (7 %) vs. 1/21 (4 %), respectively]. Among LBW neonates, mortality, but not CNM, was significantly higher in the PIP [16/149 (7 %) vs. 2/163 (1 %), p < 0.0001 and 10/149 (6 %) vs. 5/163 (3 %), p = 0.2, respectively]. The proportion of macrosomic neonates transferred to the Neonatal Intensive Care Unit was significantly higher in the PIP [50/76 (65 %) vs. 0/21 (0 %), p < 0.0001]. Age, body mass index, and delivery mode did not independently predict CNM. CONCLUSION Samoan women have higher rates of macrosomia and lower rates of LBW compared to Caucasians, suggesting an anthropomorphic basis of this phenomenon.
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Affiliation(s)
- Michael Tsitas
- Department of Obstetrics and Gynecology, Ruhr University Bochum-Marienhospital Herne, Hoelkeskampring 40, 44625, Herne, Germany
| | - Bernd C Schmid
- Gynecology Department, University of Adelaide, Adelaide, Australia
| | - Martin K Oehler
- Gynecology Department, University of Adelaide, Adelaide, Australia
| | - Clemens B Tempfer
- Department of Obstetrics and Gynecology, Ruhr University Bochum-Marienhospital Herne, Hoelkeskampring 40, 44625, Herne, Germany.
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135
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Iessa N, Bérard A. Update on Prepregnancy Maternal Obesity: Birth Defects and Childhood Outcomes. J Pediatr Genet 2015; 4:71-83. [PMID: 27617118 PMCID: PMC4918711 DOI: 10.1055/s-0035-1556739] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 01/25/2015] [Indexed: 12/16/2022]
Abstract
Obesity is a growing global health epidemic. It is estimated that more than 20% of pregnancies are complicated by obesity. Prepregnancy obesity has been associated with birth defects such as neural tube defects, macrosomia, fetal death, and long-term effects such as asthma on the offspring. We provide a summary of the most recent studies and meta-analyses on obesity and birth outcome. Possible mechanisms of actions are explored and recommendations for further research are highlighted.
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Affiliation(s)
- Noha Iessa
- Faculty of Pharmacy, University of Montreal, Montreal, Québec, Canada
- Research Center, CHU Sainte-Justine, Montreal, Québec, Canada
| | - Anick Bérard
- Faculty of Pharmacy, University of Montreal, Montreal, Québec, Canada
- Research Center, CHU Sainte-Justine, Montreal, Québec, Canada
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136
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Graves E, Hill DJ, Evers S, Van Aarsen K, Yama B, Yuan S, Campbell MK. The impact of abnormal glucose tolerance and obesity on fetal growth. J Diabetes Res 2015; 2015:847674. [PMID: 25977929 PMCID: PMC4421033 DOI: 10.1155/2015/847674] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/30/2015] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Factors linked with insulin resistance were examined for their association with large-for-gestational-age (LGA) infant birth weight and gestational diabetes. STUDY DESIGN Data came from a longitudinal cohort study of 2,305 subjects without overt diabetes, analyzed using multinomial logistic and linear regression. RESULTS High maternal BMI (OR = 1.53 (1.11, 2.12)), height (1.98 (1.62, 2.42)), antidepressant use (1.71 (1.20, 2.44)), pregnancy weight-gain exceeding 40 pounds (1.79 (1.25, 2.57)), and high blood sugar (2.68, (1.53, 5.27)) were all positively associated with LGA birth. Strikingly, the difference in risk from diagnosed and treated gestational diabetes compared to women with a single abnormal glucose tolerance test (but no diagnosis of gestational diabetes) was significant (OR = 0.65, p = 0.12 versus OR = 2.84, p < 0.01). When weight/length ratio was used instead, different factors were found to be significant. BMI and pregnancy weight-gain were found to influence the development of gestational diabetes, through an additive interaction. CONCLUSIONS High prepregnancy BM, height, antidepressant use, pregnancy weight-gain exceeding 40 pounds, and high blood sugar were associated with LGA birth, but not necessarily infant weight/length ratio. An additive interaction between BMI and pregnancy weight-gain influenced gestational diabetes development.
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Affiliation(s)
- Erin Graves
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada N6A 5C1
| | - David J. Hill
- Department of Physiology and Pharmacology, Western University, London, ON, Canada N6A 5C1
- Lawson Health Research Institute, London, ON, Canada N6C 2R5
| | - Susan Evers
- Department of Family Relations and Applied Nutrition, Guelph, ON, Canada N1G 2W1
| | - Kristine Van Aarsen
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada N6A 5C1
| | - Brie Yama
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada N6A 5C1
| | - Su Yuan
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada N6A 5C1
| | - M. Karen Campbell
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada N6A 5C1
- Lawson Health Research Institute, London, ON, Canada N6C 2R5
- Department of Obstetrics and Gynaecology, Western University, London, ON, Canada N6H 5W9
- Department of Paediatrics, Western University, London, ON, Canada N6C 2R6
- Children's Health Research Institute, London, ON, Canada N6C 2V5
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137
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Li Y, Liu QF, Zhang D, Shen Y, Ye K, Lai HL, Wang HQ, Hu CL, Zhao QH, Li L. Weight gain in pregnancy, maternal age and gestational age in relation to fetal macrosomia. Clin Nutr Res 2015; 4:104-9. [PMID: 25954731 PMCID: PMC4418414 DOI: 10.7762/cnr.2015.4.2.104] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/02/2015] [Accepted: 03/04/2015] [Indexed: 12/02/2022] Open
Abstract
To investigate the possible risk factors related to macrosomia. Pregnant women and their newborns (n = 1041) were recruited from a cohort study in Maternal and Child Care Center of Hefei from January 2011 to July 2012. Questionnaires were applied to collect the demographic data besides the medical records. Detailed health records of the entire pregnancy were obtained using retrospective study. Meanwhile the data of neonatal outcomes was prospectively tracked. Associations between exposure risk factors and macrosomia were analyzed using Pearson's chi squared test. Logistic regression models were used to assess the independent association between these potential predictors and macrosomia. The incidence of macrosomia of this cohort was 11.24% of which male: female = 2.55:1. Male incidence (8.07%) of macrosomia was higher than female (3.17%), p < 0.001. Body mass index (BMI) before pregnancy (pre-BMI), maternal height, parity were not independently associated with macrosomia; multiple logistic regression analysis indicated that macrosomia was mainly independently associated with weight gain in pregnancy (OR=1.14, 95% CI [1.10-1.19]), maternal age (OR = 1.09, 95% CI [1.03-1.15]) and gestational age (OR = 1.62, 95% CI [1.31-1.99]), respectively. Our findings indicate that weight gain in pregnancy, maternal age and gestational age should be considered as independent risk factors for macrosomia.
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Affiliation(s)
- Yi Li
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Anhui 230032, PR China
| | - Qi-Fei Liu
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Anhui 230032, PR China
| | - Dan Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Anhui 230032, PR China
| | - Ying Shen
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Anhui 230032, PR China
| | - Kui Ye
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Anhui 230032, PR China
| | - Han-Lin Lai
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Anhui 230032, PR China
| | - Hai-Qing Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Anhui 230032, PR China
| | - Chuan-Lai Hu
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Anhui 230032, PR China
| | - Qi-Hong Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Anhui 230032, PR China
| | - Li Li
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Anhui 230032, PR China
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138
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The offspring of the diabetic mother – Short- and long-term implications. Best Pract Res Clin Obstet Gynaecol 2015; 29:256-69. [DOI: 10.1016/j.bpobgyn.2014.08.004] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 08/12/2014] [Indexed: 12/25/2022]
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139
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Lin TC, Mu CF, Hsu CY. Risk factors for gestational diabetes mellitus: ethnic disparities. Aust J Rural Health 2015; 23:176-80. [PMID: 25614928 DOI: 10.1111/ajr.12151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) increases the risk of poor maternal and infant health outcomes; therefore, the objective of this study was to compare the ethnic disparities and identify the risk factors for GDM. DESIGN We performed a cross-sectional analysis using patient records from a hospital located in the Puli area of Central Taiwan. SETTING A teaching hospital located in a rural mountainous area of Central Taiwan. PARTICIPANTS Between 2002 and 2012, the hospital admitted 154 patients (107 non-aborigines, 30 aborigines, and 17 non-Taiwanese) who exhibited glucose intolerance during their pregnancy. MAIN OUTCOME MEASURES GDM was confirmed using the oral-glucose-tolerance-test administered in dose of either 100 g or 75 g. The incidence and risk factors for GDM in the aboriginal and non-aboriginal women was compared. RESULTS We excluded the patients who had overt diabetes or were non-Taiwanese. Thus, 132 patients (28 aboriginal and 104 non-aboriginal women; mean age 30 years) were enrolled in the final study. A total of 51 patients (15 aboriginal, 36 non-aboriginal women) had GDM, which was more prevalent among the aboriginal mothers (53.6% versus 34.6%). The risk factors for GDM among the aboriginal women were persistent glycosuria and prior macrosomia. CONCLUSION The Taiwanese aboriginal women exhibited higher incidence of GDM; thus, we recommend that early screening and health education for pregnant aboriginal women be provided.
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Affiliation(s)
- Tzu-Chi Lin
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Chia-Fen Mu
- Department of Family Medicine, Puli Christian Hospital, Puli, Taiwan
| | - Chao-Yu Hsu
- Department of Family Medicine, Puli Christian Hospital, Puli, Taiwan.,Department of Medical Education and Research, Puli Christian Hospital, Puli, Taiwan.,National Chi Nan University, Puli, Taiwan.,Central Taiwan University of Science and Technology, Taichung, Taiwan.,National Taichung University of Science and Technology, Taichung, Taiwan.,Chaoyang University of Technology, Taichung, Taiwan.,National Chin-Yi University of Technology, Taichung, Taiwan.,Feng Chia University, Taichung, Taiwan
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140
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Ryckman KK, Spracklen CN, Smith CJ, Robinson JG, Saftlas AF. Maternal lipid levels during pregnancy and gestational diabetes: a systematic review and meta-analysis. BJOG 2015; 122:643-51. [PMID: 25612005 DOI: 10.1111/1471-0528.13261] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lipid levels during pregnancy in women with gestational diabetes mellitus (GDM) have been extensively studied; however, it remains unclear whether dyslipidaemia is a potential marker of preexisting insulin resistance. OBJECTIVE To evaluate the relationship between lipid measures throughout pregnancy and GDM. SEARCH STRATEGY We searched PubMed-MedLine and SCOPUS (inception until January 2014) and reference lists of relevant studies. SELECTION CRITERIA Publications describing original data with at least one raw lipid (total cholesterol, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], or triglyceride) measurement during pregnancy in women with GDM and healthy pregnant controls were retained. DATA COLLECTION AND ANALYSIS Data extracted from 60 studies were pooled and weighted mean difference (WMD) in lipid levels was calculated using random effects models. Meta-regression was also performed to identify sources of heterogeneity. MAIN RESULTS Triglyceride levels were significantly elevated in women with GDM compared with those without GDM (WMD 30.9, 95% confidence interval [95% CI] 25.4-36.4). This finding was consistent in the first, second and third trimesters of pregnancy. HDL-C levels were significantly lower in women with GDM compared with those without GDM in the second (WMD -4.6, 95% CI -6.2 to -3.1) and third (WMD -4.1, 95% CI -6.5 to -1.7) trimesters of pregnancy. There were no differences in aggregate total cholesterol or LDL-C levels between women with GDM and those without insulin resistance. AUTHOR'S CONCLUSIONS Our meta-analysis shows that triglycerides are significantly elevated among women with GDM compared with women without insulin resistance and this finding persists across all three trimesters of pregnancy.
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Affiliation(s)
- K K Ryckman
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
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141
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Fetal growth is associated with maternal fasting plasma glucose at first prenatal visit. PLoS One 2014; 9:e116352. [PMID: 25551824 PMCID: PMC4281143 DOI: 10.1371/journal.pone.0116352] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 12/05/2014] [Indexed: 01/21/2023] Open
Abstract
Aims Fasting plasma glucose (FPG) concentration measured at the first prenatal visit is a predictor of gestational diabetes mellitus (GDM); however, whether this test is indicative of fetal growth has not been clarified. Thus, the purpose of this study was to determine whether birth weight and birth length were related to FPG levels at the first prenatal visit. Materials and Methods Research samples were collected from pregnant women who took an FPG test at their first prenatal visit (10–24 gestational weeks), received regular prenatal care, and delivered in our center. FPG value, maternal pre-gravid BMI, weight gain before FPG test, before and after Oral Glucose Tolerance Test (OGTT), neonatal birthweight, birth length, Ponderal Index and birthing method were recorded for analysis. Data were analyzed by independent sample t test, Pearson correlation, and Chi-square test, followed by partial correlation or logistic regression to confirm differences. Statistical significance level was α = 0.05. Results 2284 pregnant women, including 462 GDM and 1822 with normal glucose tolerance (NGT) were recruited for the present study. FPG concentration at the first prenatal visit was associated with neonatal birth weight (partial correlation coefficient r′ = 0.089, P<0.001) and birth length (partial correlation coefficient r′ = 0.061, P = 0.005), but not with Ponderal Index or birthing method. Maternal pre-gravid BMI was associated with FPG value (partial correlation coefficient r′ = 0.113, P<0.001). FPG concentration at the first prenatal visit (OR = 2.945, P<0.001), weight gain before OGTT test (OR = 1.039, P = 0.010), and age (OR = 1.107, P<0.001) were independent related factors of GDM. Conclusion Fasting plasma glucose concentration at the first prenatal visit is associated with fetal growth. Maternal pre-gravid BMI and weight gain are related to glucose metabolism.
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Ryckman KK, Rillamas-Sun E, Spracklen CN, Wallace RB, Garcia L, Tylavsky FA, Howard BV, Liu S, Song Y, LeBlanc ES, White MV, Parikh NI, Robinson JG. Ethnic differences in the relationship between birth weight and type 2 diabetes mellitus in postmenopausal women. DIABETES & METABOLISM 2014; 40:379-85. [PMID: 24751988 PMCID: PMC4638122 DOI: 10.1016/j.diabet.2014.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 03/19/2014] [Accepted: 03/22/2014] [Indexed: 12/11/2022]
Abstract
AIM The objective of this study is to examine the relationship between self-reported birth weight and the adult occurrence of type 2 diabetes mellitus in a large multi-ethnic population of women. METHODS Baseline data from the Women's Health Initiative Observational Study [n=75,993] was used to examine the association between participant birth weight category and prevalent type 2 diabetes mellitus. Models were adjusted for age, ethnicity, body mass index and other pertinent risk factors. Sub-analyses were performed stratifying by ethnicity. RESULTS There was a strong inverse association between birth weight and type 2 diabetes mellitus with a birth weight of <6 pounds (lbs) (OR: 1.16, 95% CI: 1.01, 1.33) significantly associated with an increased risk of type 2 diabetes mellitus and a birth weight of ≥10 lbs (OR: 0.72, 95% CI: 0.57, 0.92) associated with a decreased risk of type 2 diabetes mellitus compared to women who reported their birth weight between 7 and 8 lbs 15 ounces (oz). Stratifying by ethnicity, the inverse association between birth weight and type 2 diabetes mellitus was only apparent in White women, but not Black, Hispanic or Asian women. CONCLUSION Lower birth weight was associated with increased T2D risk in American White and Black post-menopausal women.
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Affiliation(s)
- K K Ryckman
- Department of Epidemiology, University of Iowa, 145 North Riverside Drive, S400 CPHB, Iowa City, IA 52242, United States.
| | - E Rillamas-Sun
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA 98109, United States
| | - C N Spracklen
- Department of Epidemiology, University of Iowa, 145 North Riverside Drive, S400 CPHB, Iowa City, IA 52242, United States
| | - R B Wallace
- Department of Epidemiology, University of Iowa, 145 North Riverside Drive, S400 CPHB, Iowa City, IA 52242, United States; Department of Internal Medicine, University of Iowa, 145 North Riverside Drive, S400 CPHB, Iowa City, United States
| | - L Garcia
- Department of Public Health Sciences, University of California at Davis, Med Sci 1C, Davis, CA, United States
| | - F A Tylavsky
- Department of Preventive Medicine, University of Tennessee Health Science Center, 600 Jefferson Avenue, Memphis, TN 38105, United States
| | - B V Howard
- Medstar Health Research Institute and Georgetown/Howard Universities Center for Clinical and Translational Research, 6525 Belcrest Road #700, Hyattsville, MD, United States
| | - S Liu
- Department of Epidemiology, University of California, Box 951740, 27-138 CHS, Los Angeles, CA 90095, United States
| | - Y Song
- Department of Epidemiology, University of California, Box 951740, 27-138 CHS, Los Angeles, CA 90095, United States
| | - E S LeBlanc
- Kaiser Permanente Center for Health Research, 3800 N Interstate Avenue, Portland, OR 97227, United States
| | - M V White
- Department of Family, Community and Rural Health, The Commonwealth Medical College, Medical Sciences Building, Room 1013, 525 Pine Street, Scranton, PA 18509, United States
| | - N I Parikh
- John A. Burns School of Medicine and Cardiovascular Division, University of Hawaii, The Queens Medical Center, 1301 Punchbowl Street, Honolulu, HI 96813, United States
| | - J G Robinson
- Department of Epidemiology, University of Iowa, 145 North Riverside Drive, S400 CPHB, Iowa City, IA 52242, United States; Department of Internal Medicine, University of Iowa, 145 North Riverside Drive, S400 CPHB, Iowa City, United States
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Jeve YB, Konje JC, Doshani A. Placental dysfunction in obese women and antenatal surveillance strategies. Best Pract Res Clin Obstet Gynaecol 2014; 29:350-64. [PMID: 25457859 DOI: 10.1016/j.bpobgyn.2014.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
Abstract
This review is aimed at discussing placental dysfunction in obesity and its clinical implication in pregnancy as well as an antenatal surveillance strategy for these women. Maternal obesity is associated with adverse perinatal outcome. Obesity is an independent risk factor for fetal hyperinsulinaemia, birthweight and newborn adiposity. Maternal obesity is associated with childhood obesity and obesity in adult life. Obesity induces a low-grade inflammatory response in placenta, which results in short- and long-term programming of obesity in fetal life. Preconception and antenatal counselling on obstetrics risk in pregnancy, on diet and lifestyle in pregnancy and on gestational weight gain is associated with a better outcome. Fetal growth velocity is closely associated with maternal weight and gestational weight gain. Careful monitoring of gestational weight gain and fetal growth, and screening and management of obstetrical complications such as gestational diabetes and pre-eclampsia, improves perinatal outcome. The use of metformin in non-diabetic obese women is under investigation; further evidence is required before recommending it.
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144
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Secher AL, Parellada CB, Ringholm L, Asbjörnsdóttir B, Damm P, Mathiesen ER. Higher gestational weight gain is associated with increasing offspring birth weight independent of maternal glycemic control in women with type 1 diabetes. Diabetes Care 2014; 37:2677-84. [PMID: 25249669 DOI: 10.2337/dc14-0896] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We evaluate the association between gestational weight gain and offspring birth weight in singleton term pregnancies of women with type 1 diabetes. RESEARCH DESIGN AND METHODS One hundred fifteen consecutive women referred at <14 weeks were retrospectively classified as underweight (prepregnancy BMI <18.5 kg/m(2); n = 1), normal weight (18.5-24.9; n = 65), overweight (25.0-29.9; n = 39), or obese (≥30.0; n = 10). Gestational weight gain was categorized as excessive, appropriate, or insufficient according to the Institute of Medicine recommendations for each BMI class. Women with nephropathy, preeclampsia, and/or preterm delivery were excluded because of restrictive impact on fetal growth and limited time for total weight gain. RESULTS HbA1c was comparable at ∼6.6% (49 mmol/mol) at 8 weeks and ∼6.0% (42 mmol/mol) at 36 weeks between women with excessive (n = 62), appropriate (n = 37), and insufficient (n = 16) gestational weight gain. Diabetes duration was comparable, and median prepregnancy BMI was 25.3 (range 18-41) vs. 23.5 (18-31) vs. 22.7 (20-30) kg/m(2) (P = 0.05) in the three weight gain groups. Offspring birth weight and birth weight SD score decreased across the groups (3,681 [2,374-4,500] vs. 3,395 [2,910-4,322] vs. 3,295 [2,766-4,340] g [P = 0.02] and 1.08 [-1.90 to 3.25] vs. 0.45 [-0.83 to 3.18] vs. -0.02 [-1.51 to 2.96] [P = 0.009], respectively). In a multiple linear regression analysis, gestational weight gain (kg) was positively associated with offspring birth weight (g) (β = 19; P = 0.02) and birth weight SD score (β = 0.06; P = 0.008) when adjusted for prepregnancy BMI, HbA1c at 36 weeks, smoking, parity, and ethnicity. CONCLUSIONS Higher gestational weight gain in women with type 1 diabetes was associated with increasing offspring birth weight independent of glycemic control and prepregnancy BMI.
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Affiliation(s)
- Anna L Secher
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Clara B Parellada
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Lene Ringholm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Björg Asbjörnsdóttir
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Abstract
Diabetes in pregnancy represents a risk condition for adverse maternal and feto-neonatal outcomes and many of these complications might occur during labor and delivery. In this context, the obstetrician managing women with pre-existing and gestational diabetes should consider (1) how these conditions might affect labor and delivery outcomes; (2) what are the current recommendations on management; and (3) which other factors should be considered to decide about the timing and mode of delivery. The analysis of the studies considered in this review leads to the conclusion that the decision to deliver should be primarily intended to reduce the risk of stillbirth, macrosomia, and shoulder dystocia. In this context, this review provides useful information for managing specific subgroups of diabetic women that may present overlapping risk factors, such as women with insulin-requiring diabetes and/or obesity and/or prenatal suspicion of macrosomic fetus. To date, the lack of definitive evidences and the complexity of the problem suggest that the "appropriate" clinical management should be customized according with the clinical condition, the type and mode of intervention, its consequences on outcomes, and considering the woman's consent and informed decisions.
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Affiliation(s)
- Gianpaolo Maso
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Via dell'Istria 65/1, Trieste, 34137, Italy,
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